阻塞性睡眠呼吸暂停低通气综合征MSCT研究

MSCT in patients with obstructive sleep apnea hypopnea syndrome

目的:评价上气道多层螺旋CT多呼吸时相扫描及后处理技术对阻塞性睡眠呼吸暂停低通气综合征(OS-AHS)的诊断价值。方法:对68例OSAHS患者和65例健康志愿者分别在平静呼吸、深吸气末、深呼气末及闭口堵鼻深吸气(Müller呼吸)这4个呼吸时相于清醒状态下行上气道MSCT扫描,测量不同呼吸时相鼻咽区、腭咽区、舌咽区和会厌区的前后径、左右径和截面积,软腭长径及厚径以及鼻咽顶壁厚径,采用仿真内镜法观察上气道形状。结果:上气道软腭长径、厚径和鼻咽顶壁厚径OSAHS组均大于对照组;鼻咽区、腭咽区、舌咽区OSAHS组各径线和截面积均小于对照组,并以腭咽区最严重,舌咽区次之。OSAHS组上气道失去正常横置椭圆形结构,咽区可多时相、多部位完全阻塞。仿真内镜观察咽腔显著狭小,甚至不能通过。结论:上气道多层螺旋CT多呼吸时相扫描及后处理技术能够准确诊断OS-AHS患者咽腔狭窄部位、程度,对临床治疗方案的选择具有重要指导作用。

Objective：To assess the diagnostic value of MSCT with multi-respiratory phase scanning and post-processing techniques of the upper airway in obstructive sleep apnea hypopnea syndrome（OSAHS）.Methods：The upper airway of 68 cases with OSAHS and 65 healthy volunteers as controls in supine position was scanned with MSCT in four respiratory phases：regular respiration,deep inspiration,deep expiration,and Müller action while they were awake.The anteroposterior diameter,transverse diameter,cross-sectional area at nasopharyngeal,velopharyngeal,glossopharyngeal and epiglottis area,the length and thickness of soft palate and the thickness of nasopharynx top wall were measured in different respiratory phases.The shape of upper airway was demonstrated by CT virtual bronchoscopy（VE）.Results：The length and thickness of soft palate,the thickness of nasopharynx top wall in OSAHS were all larger than the controls.The anteroposterior diameter,transverse diameter,cross-sectional area at nasopharyngeal,velopharyngeal,and glossopharyngeal area in OSAHS were smaller than the controls,and the velopharyngeal area was the smallest while the glossopharyngeal area was the second small.The upper airway lost its transverse elliptic structure in OSAHS.The upper airway in OSAHS had complete multi-site obstructions in multi-respiratory phase.The pharyngeal cavity demonstrated significant narrowing or even complete obstruction in virtual endoscopy（VE）.Conclusion：MSCT with multi-respiratory phase scanning and post-processing techniques of upper airway can accurately evaluate the extent and degree of pharyngeal stenosis in OSAHS patients and play an important role for clinical treatment.